Falke Charlotte, Karapinar Fatma, Bouvy Marcel, Emmelot Mariëlle, Belitser Svetlana, Boland Benoit, O'Mahony Denis, Murphy Kevin D, Haller Moa, Salari Paola, Schwenkglenks Matthias, Rodondi Nicolas, Egberts Toine, Knol Wilma
Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands.
Eur Geriatr Med. 2024 Dec;15(6):1713-1723. doi: 10.1007/s41999-024-01036-4. Epub 2024 Aug 20.
To explore the association between medication use-related factors and health-related quality of life (HRQoL) in older hospitalised multimorbid patients with polypharmacy.
This cross-sectional study used the intervention arm data of the OPERAM trial (hospitalised patients ≥ 70 years with polypharmacy). HRQoL was assessed using the visual analogue scale (EQ-VAS) and the EQ-5D index score of the EuroQol questionnaire (EQ-5D-5L). Lower or higher EQ-VAS/EQ-5D was based on the median of the study population. Medication use-related factors included hyperpolypharmacy (≥ 10 medications), anticholinergic and sedative burden, appropriateness of medication (STOPP/START criteria), high-risk medication for hospital (re)admission, medication complexity and adherence. Multivariable logistic regression analysis was used to assess the association between medication use-related factors and HRQoL.
A total of 955 patients were included (mean age 79 years, 46% female, median EQ-VAS of 60, median EQ-5D of 0.60). Opioids use was associated with lower EQ-5D and EQ-VAS (aOR EQ-5D: 2.10; 95% CI 1.34-3.32, EQ-VAS: 1.59; 1.11-2.30). Hyperpolypharmacy (aOR 1.37; 1.05-1.80), antibiotics (aOR 1.64; 1.01-2.68) and high medication complexity (aOR 1.53; 1.10-2.15) were associated with lower EQ-VAS. A high anticholinergic and sedative burden (aOR 1.73; 1.11-2.69), presence of multiple prescribing omissions (aOR 1.94; 1.19-3.17) and benzodiazepine use (aOR 2.01; 1.22-3.35) were associated with lower EQ-5D. Especially in hyperpolypharmacy patients, high anticholinergic and sedative burden and medication complexity were associated with a lower HRQoL.
Several medication use-related factors are significantly associated with a lower HRQoL in hospitalised older patients. Medication complexity is a novel factor, which should be considered when evaluating medication use of older patients with hyperpolypharmacy.
探讨老年住院多病共存且用药过多患者的用药相关因素与健康相关生活质量（HRQoL）之间的关联。
本横断面研究使用了OPERAM试验的干预组数据（≥70岁的住院用药过多患者）。使用视觉模拟量表（EQ-VAS）和欧洲五维健康量表问卷（EQ-5D-5L）的EQ-5D指数评分评估HRQoL。EQ-VAS/EQ-5D较低或较高是基于研究人群的中位数。用药相关因素包括用药过多（≥10种药物）、抗胆碱能和镇静负担、用药合理性（STOPP/START标准）、导致住院（再）入院的高风险药物、用药复杂性和依从性。采用多变量逻辑回归分析评估用药相关因素与HRQoL之间的关联。
共纳入955例患者（平均年龄79岁，46%为女性，EQ-VAS中位数为60，EQ-5D中位数为0.60）。使用阿片类药物与较低的EQ-5D和EQ-VAS相关（调整后比值比EQ-5D：2.10；95%置信区间1.34-3.32，EQ-VAS：1.59；1.11-2.30）。用药过多（调整后比值比1.37；1.05-1.80）、使用抗生素（调整后比值比1.64；1.01-2.68）和用药复杂性高（调整后比值比1.53；1.10-2.15）与较低的EQ-VAS相关。抗胆碱能和镇静负担高（调整后比值比1.73；1.11-2.69）、存在多处处方遗漏（调整后比值比1.94；1.19-3.17）和使用苯二氮䓬类药物（调整后比值比2.01；1.22-3.35）与较低的EQ-5D相关。特别是在用药过多的患者中，抗胆碱能和镇静负担高以及用药复杂性与较低的HRQoL相关。
在住院老年患者中，几种用药相关因素与较低的HRQoL显著相关。用药复杂性是一个新因素，在评估老年用药过多患者的用药情况时应予以考虑。
